### TRANSMITA LO FOMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R ID#2958 6 Dale: _ Address : 150 9 Corb ySt Remediatio n Contractor : Environmenta l Restoration. LL C Year201 1 

### SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S n Vide o o fpropert y(DVD ) | | Befor e • Afte r| | Basemen t JT^A/t?/^ ^ J 2 Executiv e Summai y(Fina l Report )

Q ^ EP Aprovide d propert ysketc h ^

Signe d Acces s Agreemen t fo rsubject propert y D Signe d Acces s Agreemen t fo radjacen t propert U C Restoratio n Agreemen t D Settlemen t document s (i.e. , fo rdamage s o rreplacemen t o fplants ) J AConfirmatio n dat a

n Photograph s •Befor e •CrewPhoto s Q Durin g Excavatio n j [Sod I 1 3 0-daySo d • J

^

As-buil t sketc h y rCompletio n Agreeinen t signe d b ypropeit yowne r ^

Propert yclose-ou t chec k lis t signe d b yEP A n Discriptio n o fareas no t meetin g RO D cleanu p criteria . Contaminatio n lef t behin d ^0''^Utilitie s

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Propert yinformatio n fro m Dougla s Count yAssessor' s Offic e jAPropert yacces s checklis t ^Contac t Lo g „ 3026338 2 Superfun d

. ^ ^ EP ACO R signatur e Dat e

# EP A EP APropert y Clos e Ou t For m Omah aLea dSit e Propert y # : 2958 6 Propert y Address ; 150 9 Corb y S t Date/Time : Owner' s Name : Cit y O f Omah a Quad s Excavated : F 2 Contracto r Group ; Environmenta l Restoratio n(ER ) Excavatio nGenera l 

# \i^Mf 4 (o f Ye s No 1 . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio n Ye s N o v ^ house ? 2 . Ha s so dbee nlai dinal l area s tha t wer e excavated ? i ^ 3 . Doe s th e so dappear t o b e generall y health y an dgrowuig ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 4 . Ar e sodde darea s generall y firman devenl y graded ? ^ 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc htha t wate r wil l no t poo l onth e property ? t ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? ty Gates , Fence s an dRetainin g Wall s Ye s No 1 . D o gate s ope nan dclos e freely? (i f applicable ) 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? (i f applicable ) 3 . ^

Wa s damag e t o gate s o r fence s avoided ? (i f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (i f applicabie ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio navoided ? yJdOJl.K" ' 11\-{ ' 3 . Wa s damag e t o window s avoided ? 

# m 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? *i 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Wa s damag e t o driveway surface s avoided ? 

## Al i 2

^ Wa s damag e t o walkway surface s avoided ? /! > Inspectio nnote ; 

# 3 ^pi^j j ZiOit ,
Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP ARepresentativ e Date ; / . 

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### OMAH ALEA D SiT E —EP-R7-09-0 5 ENVIRONMENTA L RESTORATION , LL C WWW.ERLLC.CO M

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# EXECUTIV E SUMMARY : 2958 6 150 9 Corb ySt



# N O ISSUE S O R CONCERN S ISSUES/CONCERN S
DETAI L EXPLANATION :

### IRT H On e Call Pag e 1 o f 1
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N«brask a 

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• : ;(. . Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE TNUMBER I S 2904818 . Origina l Cal l Date : 11/18/1 1 Time : 7:1 6 a m Op : TIM2418 6 Wor k

t o Begi nDate : 11/22/1 1 Time : 7:3 0 a m State : N E County: DOUGLA S Place : OMAH A Address : 150 9 Street : CORB Y S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEAD REMOVA L Locatio n o f Work : LOCAT E TH E ENTIR E CORNE R LOT . Remarks : FA X AL L CLEAR S TO : (402) 4 51-106 9 : 2958 6 Compan y ENVIRONMENTA L RESTORATIO N Contac t Nam e TI M SUTTO N Phone : (402)451-131 4 .v;226 7 Alt . Contac t CEL L Phone : (402)306-234 7 Wor k Bein g Don e For : EP A Dept h o f Excavation : 2 4 INCHE S Corne r Lot : N Front : NRear : N Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Cod e Servic e Are a Nam e Contac t Phon e Number s Utilit y Typ e MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND YMUDO l Day : (402 ) 50 4 - 782 3 Emerg : (402 ) 50 4 - 797 0 OMAHACO F CIT YO F OMAHA - RICH/TRAFFI C Day : (402 ) 44 4 - 719 7 -rOACCTr - cc:\Mtz o o ^y l AL J A > ^



### hUp://w\\'w.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?VievvTicketrD=89809 7 11/18/201 1ENVIRONMENTA L 

# ^6Sle , ISO i M ^ RESTORATIO N 

# Question s t o answe ra t th e hous e 1 Doe s th e ma p matc h th e property ? V g <; ^ 2 I s ther e a dog ? ^3 0 3 I s ther e anythin g tha t nee d t o b e moved ? lik e a ca ro rboat ? ^3 0 4 Doe s th e propert yhave eas yaccess ? ^(g* ? 5 I s th e propert yEasy , Norma l o rHard ? ^ ^ 

# ? 6 I fno . i s ther e a propert yw e ca n ge t acces s fro m 7 I s soi l goin g t o hav e t o b e shuttle d out ? ^ 6 8 I s th e propert yal l han d work ? AJ> 0 9 I s ther e a retainin g wall ? h O . i d I s i t i n ha d shape ? 1 1 I s ther e unde rgroun d lin e t o th e garage ? ^ O 1 2 I s ther e a sewe rclea n out ? jijf ^ 1 3 Istherean yhazard s i n th e yard ? AJ Q 1 4 I s th e sidin g ol d o n th e house ? j>C> T 1 5 Tryt o leav e th e tim e fram e ope n whe n w e wil l b e there ? A^ t 1 5 I fthe ynee d a notic e Mar k i t bi g o n th e map . Tryt o leav e i t a t a 2 4 hou rnotic e only ? AJ Q 1 7 Wha t kin d material s ar e nee d fo rreplacement ? U O 1 8 I s ther e zoysi a gras s a t th e propert y( Re d fla g thi s prooertv) ? iW 1 9 I s thi s propert yboarde rlin e o n routine ? ^^ ^ 2 0 I s ther e sentimenta l ite m b e awar e of ? IWOML 2 1 Ca n w e us e th e driveway ? ^) 0 0({i\J i t^< ^ 2 2 I s th e propert ylin e marke d i n th e excavatio n areas ? W'^ ? '
Sig n

## Contac t Informatio n Lo g SAID # 2^5'BCJ . Daytim e Phone : t^j/c/
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### Attemp t t o contac t Date/tim e Nam e
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# Propert y Acces s Checklis t SAID : D WOR K STARTE D ON : / / D WORKCOMPELTE D ON : / / Propert y A d dress : /CT) ^ 

# M l Owner : [\ LJ ^ /)^>uJ ^ Renter : 

### Address : ( / Phone : Fax : Cell/Pager : Additiona l Information : 

# "^^^^^^W^WFW/ V Fax : Cell/Pager : [ 3 Acces s Agreemen t Signed: ^ 1 f^lP 

## By : M L y Restoratio nAgreemen t Signed : S 11 ^ 1 f ( 

## By: m ^ @ Vide o Propert y Befor e 

## O n: 5 // I /J L By : M [> ^ Digita l Photo s Befor e 

## O n: 5 /li/i L By : M

• Vide o Propert y After O n: / 1 . By : ) D Digita l Photo s After O n: / / By : ^ Propert y Completio nAgreemen t 

### Signed:/. ^ 1 ZL l I L By : ^4 >

• Fina l Repor t Signed : / / By : Additiona l Vide o o r Digita l Photo' s Taken : D Vide o D Digita l Phot o O n: / By : Reason : nVide o nDigita l Phot o O n By : Reason : nVide o nDigita l Phot o O n By : Reason : • Vide o nDigita l Phot o O n By : Reason :

## A ^ t SAI D 

# m Consen t fo rAcces s t o Propert y 

# :?fs-s( ^ RIGH T O FENTRY T O PREMISE S 

### Granto r (the propert y owner) , consent s t o an dauthorize s th e Unite dState s Environmenta l Protectio nAgenc y (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfor mcertai nenvironmental respons e activitie s upo nth e followin g describe dpremises : j Owner' s Name : /»/ ) ^ Qtl^^ ^ Daytim e Phone : ^^rVVV^J^l* ^ Address : /^ ^ ^ (}oAj_Sr _ Address : ^ Addresse s of Propertie s Address : covere db y thi s Agreement : Address : Address : PURPOS EO FINVESTIGATIO N 

### Th e purpos e o f th e remedia l activitie s i s t o remov e al l soil s at th e propert y whic hare contaminate dwit hhazardou s substances , i nparticular leada t concentration s greate r thano r equa l to 40 0 part s pe r millio n(ppm) . REMEDIALACTION S The environmenta l respons e action s to b e performe do nsai dproperty ma y includ e th e foiiowin g activities : a .Takin g photograph s and/o r vide o o f th e property before , during , an dafter remedia l activities ; b .Locatin g equipmen t an dmachinery on-sit e inpreparatio nfor an di nth e cours e o f th e envirormienta l response ; c .Plannin g an dimplementin g the removal actio no no r near Grantor' s property . d .Obtainin g sample s fromGrantor' s property ; AGREEMEN T NO T T O INTERFERE 

### Th e Granto r agree s not t o interfer e o r tampe r wit han y o f th e activitie s o r work done , o r th e equipmen t use dto performth e activities , o r to undertak e an y action s regardin g th e us e o f sai d property whic hwoul dten dto endange r th e healtho r welfar e o f th e Grantee s o r th e environment , or

t

o allo w other s t o us e th e propert y i nsuc h Q I d ono t gran t acces s t o m y propertie s 

# ' ^ y I gran t acces s t o m y propertie s

Dat e Q Signatur e Dat e

### n Chec k thi s boxi fowne rdoe s no t wan t E.R . t o ente rth e resident s t o documen t interio r foundatio n wall s an d possibl e preexistin g damage . B ycheckin g thi s bo xE.R . i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures .

nI d o no t agre e p ^ I agre e i I [ d o no t agre e Qla g re e 

# yp.-i^ f Owner' s Signatur e Dat e s Signatur e Dat e

### % 

## estoratio n Agreemen t Th e purpos e o f thi s agreemen t i s to provid e amutual agreement a s t o condition s o f propert y prio r t o contracto r activities . Thi s wil l als o ser\' e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dto th e satisfactio no f th e property owner an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert yAddress : /^ ^ ^ (J ^

Jy ^ 

### Owner ; Phon^ : ^(-fO^ ~ t^i-fLf ' LfZ>^ ^ 

### Onth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddept ho f excavation , locatio no f al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dthe directio no f North . Indicat e distances , depths , material types , etc . Indicat e digita l photo s b y referencin g th e photo-lo g number wit ha narro w indicatin g directio no f view . Item s t o b e remove d b yContracto ran d no t replaced :

Item : 

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- -^^^ ^ ttem: Item : Item : item : Item : Item :

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# Xk I agre e C U 1 d o no t agre e 

# 0 i agre e C U I d o no t agre e

Owner'sxS^natur e Dat^ ' CoawSSt o or' s STgfeattir e Dat e 

### Attachmen t

Pag e 2 o f 212/05/201 1 MO N8:1 9 PA X 121002/00 5 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedia l activitie s perfonnedo nm y property . M y signatur e wil l designat e tha t I a msatisfiedwit hthe restorationof m y property , andtha t n o item s ar e i n question , now , o r a

t an y tim e i nthe future , except thos e items liste dbelow , ifany . 'SAW : A^^ ^ ~ ^ Propert y Addre., : y^g ^ p^J, ^ Ovrner ; vkZZ ^ 1 i 111 1 Phon e 

# ^2^-^^^ ' m w Restoratio n Item s I n Question :

Item : t item :

Item : Item : Kem : 

### Item : Additiona l Comments :

r Ai Mgre e reitoratio nIs completed , except l u note d •f l I agre e restoratio n( s completed . esG«p t a

anote d L J I do no t agre e restorationIs completed Q I do Do t agre e reat o ratio nIs complete d 

## y^

~ 7-^6/ / 

# ^^=.—^^--^- v Owner' s «lgiSur e Contractor' s Sigfia t t>9itf l Dat e atur e

### Dougla s Coimt y Accoun t Informatio n Fag e I ot 2 Dougla s County , Nebrask a Propert yRecor d - R174409000 0 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f2011-3-3 1 Treasurer' s Ta xRepor t Ne wFeatur e <- > < 4 > > Subdivisio n Sale s Searc h Owne r CITYO F OMAH A C/

O CITYFINANC E 1819FARNAMS T OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 440 9 000 0 1 7 Accoun t Type : E xGovernmen t Parce l Number : 174409000 0 Parce l Address : 150 9 CORB YS T OMAH AN E 68110-000 0 Lega l Description : MILLAR D & CALDWELL' S AD D LO T111/ 2 BLOC K0 W3 4 E 17 0 FT3 4 X 8 6 5/ 8 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $0.0 0 $0.0 0 $800.0 0 $800.0 0 $800.0 0 $800.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $0.0 0 $0.0 0 $800.0 0 $800.0 0 $800.0 0 $800.0 0 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 6 2924. 0 0. 0 86. 0 34. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl7. . . 4/13/201 1

### Dougla s County Accoun t Informatio n Pag e 2 o f 2

Th e abov e ma p i s powere d b yGoogle , an d I s intende d t o provid e a genera l ide a o fa property' s location . I f yo u requir e a more exact propertylocation , yo u ma yus e th e Interactiv e GI S Map s tha t ar e maintaine d byou r office .



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 7.. . 4/13/201 1

# • • AS-BUIL TDRAWIN G ENVIRONMENTA L OMAH ALEA D SUPERFUN D SIT E RESTORATIO N Contract * EP-R7-09-0 5 

# 11111 1 2958 6 Exterio rPain t Nort hAn-o w Sit e Sketc h Omah a Lea d Sit e n Goo d 

# Q>^q
- HzJ^ r \ r~ l Poo r Samplin g Address : 150 9 CORB YST ^ 3 * '^° ' pain t Sampl e Numbe r Lea d Co rcentratio n XR F LA B Sample s Collecte d RY.^SCPXA-2958 6 F l Fir m 

# ±ai . pp m Q- 

# n Dat e RYBSCPXA-2958 6 F2 

### JsS- . pp m 

# • 0 RYCSCPXA-2958 6 B l Tim e 

### S h pp m RYDSCPXA-2958 6 B2 

# m. pp m 

# • Sample s Analyze d RDZOCPXA'^2900 G GS r r?CjZSCPXA-2950 6 S2 - pp m 

# • • XR F Unit ; tOB& ^ Book : ^/, A pp m pp m r?PZOCPXA-2050 6 H= * 

# • L3 Date : Time : Numb e ofSample s = | ^^ | [ Q ) Staff : 

### M<;u/ 

## i: Legend : F1 = Fron t Left , F2 ^ Fron t Right , 31 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ •- Garden , ^2 . = Pla ^ quadr a is ar e as viewe d from th e street , facin g propert y 

### OC T 1 4 

### 201 0

SAI D #2958 6 DAT E EXCAVATE D 11-30-1 1 DAT E EP A SIGNE D OF F 12-8-1 1

ARE ASODDE D 140 4 SQ FT

RCV20O S Crearted : 14-Sep
- 

### •• CeeiV.^ t O447O1.01.2 3

LEGEN D Easemen t Excavate d Quadran t Excavate d Drip Zon e Excavate d Lea d Soi l Remainin g

## 2958 6 Omah a Lea d Sit e Exterio rPain t Nort h Arro w 

### ^V'^ ­ HlH rSit e Sketc h 1 • • Good Poo r 

# f Samplin q Address : 150 9 CORB YS T 0 * No t pain t Sampl e Numbe r Lea d Concentratio n XR F LA B Sample s Collecte d RYASCPXA-2958 6 F 1 pp m 

## D Firm ; Date : RYBSCPXA-2958 6 F 2 

## J^S ^ pp m 

# 0 D ID'J-^-ZO/ O Time : RYCSCPXA-2958 6 B 1 pp m 

# 0 D 

# 2± . RYDSCPXA-2958 6 8 2 pp m 

## B D Sample s Analyze d 

# M n!DZOOr)(A-29!}0 0 BE - pp m 

## D 

# n XR F Unit : lOBU ^ Book : .?/ ^ r?GZ0CPXA-2950 6 S2 - pp m 

## D D Date : RPZSCPXA-2050 6 PE - pp m 

## D D Time : Numtje ro fSample s = | ^ | | Q | Staff : 

## n%j L Legend : F 1 = Fron t Left . F 2 = Fron t Rigtit . B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ^ A l quadrant s ar e a s viewe d fro m th e street , fadn g propert y 

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## .(^S.^.^t . ; . Re v 200 8 Created : 14-Sep-l O

## 2958 6 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Good 

### Sit e Sketc h 

# VW
- H2Hr Q Poo r 

### \ Samplin g Address : 150 9 CORB YS T luT " Not pain t Sampl e Numfcie r Lea d Concentratio n XR F LA B Sample s Collecte d RYASCPXA-2958 6 F l pp m 

## B- D Fir m 

### ?£-m c MW//eiA / RYBSCPXA-2958 6 F 2 

### SiS ^ pp m 

## 0 Dat e 

### lG'14-ZOt O 

# n RYCSCPXA-2958 6 B 1 

## 0 Tim e 

### S U pp m 

## D RYDSCPXA-2958 6 8 2 

## 0 Bi__pp m Sample s Analyze d 

## D RDZOCPXA--2950 0 B2 - 

## D rr

pp m 

## D D XR F Unit : RGZOCPXA-2958 6 62 - —pp m 

## D RPZ0CPXA.2050 G Pi : —pp m 

## D Date: _ IO-20'f O 

## D Time : Numbe ro fSample s = | ^ Staff : 

# fnv/ Legend : F 1 = Fron t Left , F 2 = Fron t Rigtit , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z •• Garden , P Z = Pla ^ A l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

## OC T 1 4 201 0

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# O
RESTORATIO N SAI D #_Si5S^_ _ DAT E 

### U \3 o \( { PROPERT YADDRES S TIM E XR F S/ N 

# Tt^n ^ QUADREN TO R SAMPL E ARE A DEPT H AVERAG E O F RESULT S SHO T# s redi g 

# n F 1 

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SAMPLE R NAM EThemi o Fishe r Scientifi c 90 0 Middlese x Turnpik e 

# Therm o Billerica , M A0182 1

SCIENTIFI C

AVKRVC K ADDRKS S SAMPL K ARK AOPKRATO RDKPT H NOTK S 20M-II-3 U 15:2 7 Av g of 637-63 9 I509corbys l F 2 JIMM Y 4 final clearanc e 137.7 7 ± 20.6 7 2011-11-3 0 15:2 7 1509corbys i F 2 JIMM Y 4 final clearanc e 2958 6 130.8 6 ± 20.3 1 2011-11-3 0 15:2 7 1509corbys i F 2 JIMM Y 4 fina l clearanc e 2958 6 132.8 7 ± 20.5 0 2011-11-3 0 15:26 1509corbys t F 2 JIMM Y 4 fina l clearanc e 2958 6 149.5 8 ± 21.2 0

Pag e 1 o f 1 11/30/1 1 15:41:0 8